This retrospective cohort study aims to investigate the possible connection between patient-related factors, such as depression and anxiety, and the quality of cancer care received. Prior research suggests that patient- related factors may be the most predictive of cancer care quality. Despite that fact, most quality improvement efforts are aimed at hospital or provider factors. There is very little research on the influence of patient characteristics, especially patient-reported outcomes, on the quality of care received. Quality monitoring has increased significantly over the past ten years as the American Society of Clinical Oncology (ASCO) has developed Quality in Oncology Practice Initiative (QOPI). QOPI is a voluntary system to measure processes of care using retrospective medical record abstraction methodology. Measures included in QOPI are consensus and/or evidence based standards for high-quality cancer care developed by medical oncologists. Using an existing large cohort of patients with non-small cell lung cancer (NSCLC) who have completed validated assessments of depression and anxiety at their initial oncology consultation as part of our clinical database, we propose to examine an association between psychological symptoms, depression and anxiety, and the receipt of high-quality cancer care. Because the database is continuing to accrue participants, we propose to analyze at least 300 individuals diagnosed with stage IV NSCLC and the quality of care they received in1) diagnosis and treatment and 2) end-of-life care. Quality of cancer care data will be collected using the ASCO QOPI methodology of chart review. The existence of the clinical database facilitates the current proposal, allowing for a unique contribution in a cost-effective way. We hypothesize that depression and anxiety will each be associated with significantly worse quality scores (for both the diagnosis and treatment measures and the end-of-life care measures). This investigation will not only address the limitations of previous studies, but will also analyze aspects of psychosocial health as related to quality oncology care benchmarks that are quickly becoming the standard for oncology care. If associations are found, this would further incentivize the recognition and treatment of psychological symptoms because of its impact on quality and its ramifications with pay-for-performance in cancer care.